Multidisciplinary collaboration reveals unexpected diagnosis


As an active 87-year-old, James Freehill never suspected his pneumonia-like symptoms might be signs of an underlying bloodstream condition.

In 2018, James was diagnosed with eosinophilic pneumonia — a rare condition in which eosinophils, a type of white blood cells, accumulate in the lungs — by Valley Medical Group pulmonologist Nidal M. Matalkah, MD. Impressed with the care he received, James transferred his primary care to Valley Medical Group and began seeing primary care physician Timothy Brabston, MD.

When James began experiencing symptoms similar to his previous diagnosis of eosinophilic pneumonia, including shortness of breath, water retention in his legs, chest pain and a deep cough, he visited Dr. Brabston for a further evaluation.

“Eosinophilic pneumonia is known to cause an increase in the number of eosinophils in the lungs and bloodstream. Having already been treated and monitored to ensure James’ lungs were not affected, I suspected that James was suffering now of an underlying cardiovascular complication,” Dr. Brabston explained. “To ensure he receives a full workup, I recommended that he follow up with a cardiologist.”

For further evaluation and diagnosis, James visited cardiologist Edward Julie, MD. To better understand James’ condition, Dr. Julie ordered three tests: an angiogram, which uses X-rays to visualize blood vessels; an echocardiogram, which uses ultrasound technology to check heart muscle, valves, and blood flow; and a stress test, used to monitor coronary blood flow from the heart.

Together, the three imaging techniques revealed a severe form of mitral valve regurgitation – a condition in which the heart’s mitral valve does not close tightly, allowing blood to flow back into the heart.

“Dr. Brabston’s instinct regarding the underlying cardiovascular complications was correct. His quick thinking and referral to a specialist had a positive impact on James’ diagnosis and treatment,” says Dr. Julie.

“Using James’ test results, I was able to determine the root cause of his recurring complications. To help with the treatment of James’ mitral valve regurgitation, I called structural heart specialist, Rajiv Tayal, MD, director of the Cardiac Catheterization Laboratory and Structural Cardiac Program at Valley Hospital, to help develop a personalized treatment plan,” said Dr. Julie.

To treat James’ mitral valve regurgitation, Dr. Tayal, with the help of Dr. Julie, performed a MitraClip™ transcatheter mitral valve repair procedure. This minimally invasive procedure allows doctors to attach an implantable, penny-sized clip to the mitral valve to help the valve close more fully. Once attached, the MitraClip helps restore breath flow through the heart.

“James was the perfect candidate to receive the MitraClip,” explained Dr. Tayal. “Based on Dr. Julie’s analysis and recommendation, I was able to successfully place the MitraClip device, significantly reducing James’ mitral regurgitation.”

Given the minimally invasive nature of the procedure, James was released from Valley several hours later.

“I didn’t want to go through a cycle where my symptoms would clear up and I would feel better, but a year later they would come back and I would feel sick again,” James said. “I trusted the opinions of Dr. Julie, Dr. Tayal and the rest of the Valley Cardiac team, so I knew the MitraClip procedure was the right decision for me.”

To help him recover, James attends outpatient cardiac rehab where he performs a series of exercise routines to improve his heart health, reduce the risk of future heart problems, and improve his quality of life.

“Valley has been wonderful for me. I encourage everyone to visit Valley to check their symptoms. All symptoms are remediable if you make a concise decision to help yourself and improve the quality of your life,” James said.


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